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Chapter 8: Tales from the COVID-19 front lines

“We’ve gone from surviving hour to hour in late March, to working day to day in April, to planning week to week in May.”

Chapter 8: Tales from the COVID-19 front lines
Patients are being seen and befriended at The Pet Hospitals, a group of seven clinics in and around Memphis, Tennessee.
This week: Veterinary practice leaders are thinking more and more about how they will provide patient care in a post-COVID world. As restrictions ease, some clinics are farther ahead than others. Read other installments in this series: Chapter 1  Chapter 2  Chapter 3  Chapter 4  Chapter 5  Chapter 6  Chapter 7  Chapter 9  Chapter 10  Chapter 11  Chapter 12  Chapter 13  Chapter 14  Chapter 15
Creative Disruption columnist and WellHaven Pet Health chief medical officer Bob Lester, DVM If you’ve read my musings of the last month or so, you’ve seen me forecast a surge. I’m happy to report the surge is on! Our profession is benefiting from a variety of tailwinds:
  • The return of flea, tick and heartworm season.
  • Americans becoming more willing to leave their homes.
  • Pent-up demand for veterinary services.
  • Record numbers of pet adoptions.
  • State governors relaxing restrictions on non-essential procedures.
The result? We’re busy! The books are nearly full. We’re helping as many pets now as pre-COVID. In some cases, more. Several of the communities our WellHaven Pet Hospitals care for have received gubernatorial blessings to resume non-essential procedures. The other communities we support forecast that within two weeks they will be allowed, too. Yahoo! The safety of ourselves and our clients remains the No. 1 priority. Curbside is how we conduct business. Enhanced biosecurity measures remain, and wearing personal protective equipment is the standard. As more states relax shelter-in-place orders, as Americans continue to embrace their new four-legged family members, as stimulus checks continue to land in mailboxes, and as we work through postponed procedures, May promises to be a good month. Perhaps June will be as well. We’ve gone from surviving hour to hour in late March, to working day to day in April, to planning week to week in May. Month to month? Who knows? Should we be in for a prolonged and profound recession, our profession will take a hit — less than in most sectors, but we’ll be impacted. In the meantime, we continue to care for pets and families, stay safe, hope for the best and plan for the worst. I’m confident our profession will weather this latest storm in fine fashion. When it gets windy, we build windmills.
Crum & Forster Pet Insurance Group assistant vice president of veterinary relations Wendy Hauser, DVM This past week, we saw the gradual loosening of restrictions on veterinary hospitals in many states and the ability to begin to provide wellness services again. Coinciding with the increase in service options for veterinarians is the call for human pediatric wellness visits. I heard concern from several sources about the difficulty in getting parents comfortable in taking their children for routine care and the feared ramifications of undervaccinations with the resurgence of dangerous diseases such as polio, diphtheria and measles. What are your plans to recapture your wellness services? Prior to COVID-19, the annual vaccination had actually morphed to a 14-month visit. Veterinary hospitals will need a plan and a focus to encourage owners to provide preventive care. Here are four ways to structure this plan.
  1. Let your owners know that you are open for business. Communicate with all clients whose pets are overdue or almost due for preventive care services. Tell them you are now able to accommodate their needs and explain what this will look like — curbside concierge care, limited access inside the hospital, drive-up services? (Pediatricians are considering the latter.)
  2. Run PiMS reports showing which pets are overdue for services and reach out in a combination of ways —phone calls, texts and emails. How will you find time for these calls? Harness the power of employees who are underemployed or cannot return to work, perhaps due to child-care issues or health concerns.
  3. Craft your message carefully. We know that COVID-19 has changed consumers’ purchasing habits. Create a compelling message that explains “why” the care is important for their pet, not just a list of services that their pet needs. Remember that pet owners in a Banfield study considered preventive care to be what their pets were fed, how their pets were exercised, and the love and attention they gave their pets every day. While all three of those are important, the last one resonates during the COVID-19 crisis.
  4. Remember to ask for the business. Don’t ask clients when they want to come in; rather, have them choose from two appointment times. If they decline to schedule, ask them whether next week would be better or when you should call back to schedule the appointment. Remember to leverage the power of your computer’s callback reminder feature.

Veterinary industry consultant Debbie Boone, CVPM With the relaxing of some restrictions, I see a mix of hope and fear. Hope that things will return to normal soon and fear that clients will not follow the safety measures needed to remain safe. Managers are once again working on new protocols for now and the weeks to come. One of my practices is rejoining her A and B teams and opening the schedule to regular hours. Another had the best April in the history of her 2-year-old practice. The second round of Paycheck Protection Program loans seemed to be more organized. A friend at Bank of America said the Small Business Administration processed 230,000 Bank of America applications on Friday alone. Telemedicine remains a blessing to car-bound clients and veterinary teams, but the variation in state board regulations is causing some upheaval. California veterinarians calling for eased restrictions presented their case to the state Veterinary Medical Board and apparently made such an impact that an early meeting was called for May 14 to revisit the guidance. South Carolina relaxed its guidance to allow digital establishment of the veterinarian-client-patient relationship as long as the state of emergency remains in effect. Large conferences, like those hosted by the American Veterinary Medical Association and VetPartners, have been canceled for August and might move to virtual events. Some veterinary team members are creating virtual conferences of their own, like the Vet Team Global Stream on May 16 and 17 with speakers Temple Grandin and Andy Roark. Then there is the new NoodleU launched by Eric D. Garcia and friends. All this just goes to show that veterinarians will find a way to learn and adapt even in challenging times.
Veterinary industry consultant and Southern California Veterinary Medical Association executive director Peter Weinstein, DVM, MBA Diana Ross or Barbra Streisand? “Do You Know Where You’re Going To” or “The Way We Were”? Now’s the time for great leaders to be GREAT LEADERS. On Groundhog Day, Punxsutawney Phil climbs out of his burrow, looks around and decides whether to climb back in after seeing his shadow, or remain outside because of cloudiness, which indicates the onset of spring. Which groundhog are you? Have you just acclimated to the new normal and haven’t begun to think about the next phase or next season? Or are you tired of the new normal and want to return to the days of yore? Or are you tired of the old normal and acclimated to the new normal, but are eager to set the precedence for the “new” new normal? What do you see in the windshield? Which of the modified services you provide will remain a part of your menu going forward? And which of the services are you eager to throw in the trash can? It is your role as a great leader to engage your team before a decision has to be made, and come up with a team-based game plan. Time to listen to others and allow them to help set the tone for the future. You have all suffered through this in some way, shape or form. Leaders must bring their team together to help stop the suffering and set the updated vision for the future of the practice. Of course, you can continue to look in the rear-view mirror and long for the past, hoping to return to the days of treating dinosaurs. So, are you Diana Ross or Barbra Streisand? Or are you Bruce Springsteen, who in “Rosalita” sings, “Someday we’ll look back on this and it will all seem funny.”
Beyond Indigo Pets CEO and Today’s Veterinary Business editorial adviser Kelly Baltzell, MA As we ride the COVID roller coaster, there are more questions than answers. If I am in a state that is reopening, what protocols do I keep? Curbside service? Do I allow people in the lobby? Should I sit tight and change policies in a few weeks? Will a surge of new COVID cases occur in states that reopen? If so, what does that mean for everyone? If my state is in lockdown, when is it going to reopen? Some states are easing restrictions on what can be done in hospitals, such as elective surgeries, even though a lockdown still exists. Does a hospital start offering those surgeries? How do we tell clients the option is available? I interviewed Dr. Hank Wright in my “View From a Hospital” YouTube series. (Check it out at https://bit.ly/3fbW9f0.) Dr. Wright practices at The Pet Hospitals in Tennessee, which is a state that is reopening businesses. He said Tennessee opened before his county, which is another variable for businesses. Just because your state is open, does that mean your county is as well? He said he is keeping his current protocols in place for a few more weeks. Then, he will test opening the lobby and deciding where people sit and stand. When asked about protocols that probably will remain because pet owners or his team like them, he mentioned curbside drop-offs and pickups for boarding and grooming. His clients like it too much! Given so much confusion, keep communicating to clients on every platform in your marketing toolkit. This includes your website, Facebook, Google My Business, email, text messaging and on-hold phone messages. You cannot communicate too much during this time.
Getting Technical columnist, practice management consultant and Patterson Veterinary University instructor Sandy Walsh, RVT, CVPM We have found our groove. Curbside is the new normal. Teams have really settled in, and it’s almost business as usual. Clinics are starting to open up the schedule to wellness visits and clients are thrilled. One of the biggest challenges now is the phone volume. With clients calling from the parking lot and other clients calling for appointments, it’s all hands on deck. During a shift last week, I noticed a higher number of chatty clients. Many had no concept of how busy we were even though I had to put them on hold multiple times to answer another line. They are paying more attention to their pets and noticing things they otherwise might have missed. That’s a good thing as the conversion rate from phone call to scheduled appointment is high. Paycheck Protection Program loans are slowly funding, and for most practices revenue is steady. Unemployment payments are slow, so employees are coming back to work. Practices are still hiring and looking toward the future.
Talk the Talk columnist, veterinary industry consultant and Today’s Veterinary Business editorial adviser Amanda L. Donnelly, DVM, MBA What I’m hearing from practices is that everyone has adjusted to curbside delivery of care and changes to employee schedules. Most practices are down in revenue, but the decline is variable. Many hospitals are still busy. The owners and managers I talk to are planning a slow transition back to having clients in exam rooms, and many are delaying that transition until June. With respect to client communications, my concern is that increasingly we will have pet owners facing cost constraints. Teams need to be trained to proactively talk about money. Undoubtedly, clients will appreciate honest, supportive discussions about the cost of care and payment options. Everyone on the team needs to know how to express empathy and walk clients through the process to apply for third-party payment plans or other financing. Practice leaders understand how valuable phone skills are now since this has become a primary way of communicating with pet owners. Doctors, nurses and client service representatives who are on the phone need to know how to engage clients and communicate the value of services. I’ve found that hospital teams have responded positively during this crisis. I worry that some leaders and employees might experience stress, fatigue and burnout as they deal with personal and professional challenges related to finances and client conversations. My biggest advice to practices is to develop and execute a 60-day plan right now while not forgetting about their 2020 business plan. This means having a weekly plan that is flexible but still staying focused on at least one or two marketing initiatives, such as increasing client compliance. Practices need to assess what has worked well the last two months, what needs to be improved and what changes should become a permanent part of the business.
The Vet Recruiter founder and CEO Stacy Pursell, CPC, CERS Over the past week, I continued to receive calls and emails from existing clients telling me they needed to hire one or more veterinarians. While we continued to do phone and video interviews, I have seen more veterinary practices inviting veterinarians to do face-to-face interviews. The practices are asking candidates to wear masks to the interview and follow certain protocols. We had someone travel to another state for an interview last weekend, and we have another candidate this week traveling to a different state for a face-to-face interview. Practices I speak with tell me they are busy and that business is good.
Today’s Veterinary Nurse editor-in-chief and NAVC director of veterinary nursing Kara Burns, MS, MEd, LVT, VTS (Nutrition) Across the country, veterinary teams are still working hard, albeit differently. Many say they are busier than pre-pandemic, while a few report being slower. As pet owners are home with their pets, they are noticing and thus calling for appointments regarding limping, pruritis and annual vaccinations, and for advice on COVID-19 and their pets, especially cats. Phone counseling to ease concerns raised by reports of pets testing positive for COVID-19 have been higher over the past two weeks. The stay-at-home orders have resulted in more households adopting a pet. This has led to calls for appointments. So, what I am hearing and experiencing is a few less appointments a day, but longer appointments. Thus, the workload does not seem to be lessened overall, just different, which seems to be the word of the times. Veterinary teams are adjusting to the “new normal.” People in general do not like change, but this change was unforeseen and we are adapting. Curbside appointments, telemedicine, face masks — the new normal. Veterinary professionals have always been the MacGyvers of medicine, and this is true now more than ever. Making and sharing personal protective equipment and social-distancing protocols are only two of the discussions taking place. The camaraderie and ingenuity are astounding but not surprising. We are vet med! Thank you for your commitment to animals and the people who love them. Veterinary medicine is essential in an inordinate number of ways. Thank you for going to work every day while most of the country cannot. Thank you for caring for pets, livestock, food production and safety, and for your work in every aspect of medicine. Thank you for your compassion during a time of unknowns. Our world and our pets are better for it because of you.
North American Veterinary Community chief veterinary officer Dana Varble, DVM The news media over the last week alerted us to COVID-19 outbreaks in workers at several meat-processing plants and now at other types of food processors. At first glance, this might not seem relevant to veterinary medicine, but veterinarians are vital in maintaining the safety of our food supply. Veterinarians serve as inspectors at nearly every meat-processing facility, and several of them have shared anonymous stories of concern about worker safety. Many veterinarians in food safety are working long hours, have been ill with COVID-19 or worry about contracting it. Many are still hopeful and express confidence in our food supply, the processing companies and the workers who make everything possible. Our thoughts and best wishes are with them as they continue their hard work. Knowing that my veterinary colleagues are hard at work brings me confidence in the availability and safety of our food supply.
North Carolina veterinarian, speaker, consultant and Today’s Veterinary Business editorial adviser Ernie Ward, DVM, CVFT “We’re getting back to work!” All across the country, veterinarians I spoke with were eager to get back to normal. As many state and local agencies began easing work restrictions, the question shifted to how to keep staff, clients and pet patients safe from SARS-CoV-2 infection in a busy veterinary clinic. Most veterinary clinics I spoke with said they would continue providing curbside service for the foreseeable future. One veterinary owner said she was advertising “valet service” for pet parents who would rather wait in their car. While curbside service has worked well during this initial pandemic phase, I don’t see it as a practical long-term solution for veterinary care. Inclement weather, rainstorms, heat waves, and the lack of interpersonal communication and worries that their “fur baby” is alone and scared, hurting or frightened will likely result in pet owners seeking other forms of care. For many cat owners, the stress and anxiety associated with curbside service is even worse, leading many to skip wellness visits. Many human parents fear their child will pick up an infection from a sick child when visiting a pediatrician. The U.S. Centers for Disease Control and Prevention released data that an alarming number of toddlers are missing essential childhood immunizations during the pandemic due to such suspicions. Many pet owners share the same worry. Some cat owners are beginning to say they’re more anxious about their cat getting COVID-19 when visiting their veterinarian than they are about themselves becoming infected. Perhaps the most obvious strategy to help allay these fears is staggered patient scheduling. In simplest terms, the clinic books wellness visits in the morning and sick patients in the afternoon. The rationale is that the clinic environment will be most aseptic in the morning after being cleaned the previous evening. By reserving time periods before any potentially infectious patients enter the building, we reduce the risk of environmental contamination. This protocol is utilized in many human medical facilities, especially pediatric practices. Separate exam rooms and waiting areas for sick and healthy pets is another strategy to calm concerns. Many of you have seen grocery stores using directional arrows on floors and at checkout to guide shoppers and encourage safe social distancing. Consider applying this tactic in your clinic. Blue arrows direct healthy pets, red arrows guide those with sick pets, and black lines indicate where to wait. I believe we’ll see innovation in protective plexiglass barriers inside clinic lobbies and exam rooms. In addition, veterinary clinics should be actively pursuing online ordering, home delivery, touchless payment options, and self-checkout. Many minor medical visits can be safely and effectively transferred to telemedicine, and I encourage my colleagues to continue expanding these services. The demand for mobile, on-demand and in-home veterinary services will grow, especially in multicat households. This continues to be an area ripe for innovation and development.
We want to hear from you: How has the COVID-19 emergency affected you, your practice or your veterinary business? Email editor Ken Niedziela at [email protected].
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